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Patient Name [PatientName]
File Number [PatientID]
Nationality [Nationality]
DOB [DOB] / [Age]
Sex [Sex]
Insurance Provider [InsuranceProvider]

EMERGENCY NURSING ASSESSMENT
Date : [DoVisit]

PART I : ED PHYSICAN ASSESSMENT

EXAM TIME: [ExamHrs] hrs.             HISTORY OF PRESENT ILLNESS:

[HistoryOfComplaints]
Analysis for
CAD Risk
NA NIL
Known CAD
Smoking
Cholesterol
HTN
Family History
DM
Others,
 
 
 
 
 

PHYSICAL EXAMINIATION PERTINENT TO THE PRESENTING COMPLAINT:
    Abnormal Findings
HEENT [txt0]
Neck [txt1]
Heart [txt2]
Lungs [txt3]
Abd / rectal
[txt4]
Pelvic / GU [txt5]
Back / Spine [txt6]
Extremities [txt7]
Neurologic [txt8]
Skin [txt9]
ASSESSMENT / PLAN

ECG:   Yes No     Interpretation : [ECGInterpretation]
X-Ray: Yes No   Interpretation : [X-RayInterpretation]
Lab:    No CBC Diff Biochem CRP Troponin Coag Profile ESR
Other, [AssPlanOther]

OTHER ORDERS :
DIAGNOSIS :

[Diagnosis]

MEDICATIONS GIVEN IN ER
[ERMedications]

 

 

 
 
 
Printed Date : [PrintDate]   Signature & Stamp
Dr. [DoctorName]
 [DocQualification] , [Speciality]